Research progress on prevention and local intervention of oral mucositis in patients with hematopoietic stem cell transplantation / 中华口腔医学杂志

Oral mucositis (OM) is a common complication during hematopoietic stem cell transplantation. When OM occurs, with the destruction of oral mucosal barrier function, the formation of oral bacterial environment is accelerated, which has a negative impact on the life quality and clinical outcomes of patients. OM can be prevented by keeping the oral cavity clean, using the mouthwash properly, and limiting the delivery of cytotoxic drugs to oral tissues. This review describes the research progress on the prevention and local intervention of OM in patients with hematopoietic stem cell transplantation, in order to provide ideas for the selection of clinical intervention and management strategies on OM, and to provide references for exploring effective management methods for OM.

Proportion and rate: connotation and understanding route / 中华流行病学杂志

Proportion and rate have multiple and overlapping meanings, which blur their concepts. Based on the existence of the states and the occurrence of the events and their measuring process, we first put forward the concept of "cumulative number of states in point time". Considering the general meaning of "rate" in mathematics and the units of the elements in indexes, this paper puts forward the concept of "the change of cumulative number of states in point time", which is equal to the commonly acknowledged concept "number of incident event within observation period" or "absolute rate", and further constructs relative rate and proportion. Proportions can be classified into three types: time-point (or rate-type) constitutional proportion, time-period incidence proportion and their synthesis, time-period constitutional proportion. The essential difference between relative rate and time-period proportions is whether the observation period is regarded as a one-unit-length fixed period which would be further moved to the description of the indexes. Furthermore, the sources populations of relative rate and proportions are exclusively those at the beginning of the observation period. Thus, we established a unified identification route about ratios, proportions, and rates, the basic indicators of categorical data in populations. These are applicable to both fixed and dynamic populations. The paper aims to clarify the connotation of the indexes and the feasible understanding route and provide some reference for the population researchers.

Continuous expression of miR-431 during lung development in Sprague-Dawley rats / 中国当代儿科杂志

OBJECTIVE@#To study the role of miR-431 in lung development and morphology.@*METHODS@#According to the stage of lung development in rats, Sprague-Dawley rats at embryonic day 16 (E16), embryonic day (E19), embryonic day (E21), postnatal day 1 (P1), postnatal day 3 (P3), postnatal day 7 (P7), postnatal day 14 (P14) and 10 weeks after birth (P10 weeks) were selected, and lung tissue samples were collected for observation. Hematoxylin-eosin staining and transmission electron microscopy were performed to observe the morphology of lung tissue. Fluorescence in situ hybridization and real-time PCR were used to measure the expression of miR-431 during the critical stages of lung development (E19, E21 and P3).@*RESULTS@#The E19 group had the formation of the lamellar body and type II alveolar epithelial cells in the fetal lung tissue. The number of lamellar bodies increased with the increasing gestational age, with aggregation and excretion. Pulmonary alveoli formed rapidly, the lung interstitium became thinner, and the microvascular system became mature after birth. Fluorescence in situ hybridization and real-time PCR showed that the expression of miR-431 gradually decreased with the increasing gestational age (P<0.05).@*CONCLUSIONS@#The systematic and continuous morphological data of lung development is obtained in this experiment. In addition, miR-431 may play an important role in the negative regulation of lung development, which provides basis and direction for further research on the mechanism of lung development and related diseases.

Misdiagnosed coronary artery disease-acute aortic syndrome: A case report / 中华创伤杂志(英文版)

It is estimated that 15% of traffic accidents cause trauma to large vessels. In about 70%-95% of cases, aortic rupture took place in the distal ligament of the left subclavian artery, whereas in the remaining cases rupture occurred in the ascending aorta above the aortic valve. Trauma to the aortic sinus and coronary arteries is rarely found in traffic accident victims. Therefore, coronary artery trauma is often misdiagnosed as coronary atherosclerotic heart disease. The present case is a 42 years old male who survived from a traffic accident. He presented with aortic sinus and left coronary artery trauma. He was misdiagnosed as having coronary atherosclerotic heart disease, and therefore wrongly given antiplatelet medicine, such as aspirin, in another hospital. Definite diagnosis was achieved in our hospital, and the patient underwent Bentall and mitral valve replacement, as well as tricuspid valvuloplasty. The aortic occlusion time during surgery was 47 min, and the total cardiopulmonary bypass time was 63 min. After surgery, transthoracic echocardiography confirmed that all the artificial valves worked sufficiently. The patient felt good and symptoms such as asthma and decreased exercise tolerance disappeared. This case taught us that acute aortic syndrome cannot be ignored when patients present with pectoralgia; antiplatelet medication should not be given before definite diagnosis.

Diagnostic value of prealbumin for severe necrotizing enterocolitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features of severe neonatal necrotizing enterocolitis (NEC), and to investigate the diagnostic value of prealbumin (PA) in neonates with severe NEC.</p><p><b>METHODS</b>The clinical data and results of routine blood test and blood biochemical test of 40 neonates with NEC (29 neonates with NEC II and 11 with NEC III) were analyzed. The multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were applied to investigate the value of PA in the diagnosis of severe NEC.</p><p><b>RESULTS</b>The multivariate logistic regression analysis showed that PA was an important index for the diagnosis of severe NEC (≥IIB). The ROC analysis showed that in the diagnosis of severe NEC (≥IIB), PA had high sensitivity (0.870) and specificity (0.647).</p><p><b>CONCLUSIONS</b>PA has a good value in the diagnosis of severe NEC.</p>

Application of RASSF1A to Noninvasive Fetal ABO Genotyping in Pregrnant Peripheral Plasma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of noninvasive fetal ABO genotyping based on RASSF1A gene with circulating cell-free fetal DNA(cffDNA) from maternal plasma.</p><p><b>METHODS</b>DNA was extracted from the O group pregnant plasma, and the presence of cffDNA was confirmed by fetal DNA maker SRY and RASSF1A. B and non-O were detected by real-time PCR, and the genotyping results were evaluated by using the serologic tests for ABO phenotyping.</p><p><b>RESULTS</b>Among the samples of 20 cases, the SRY was found in 11 cases by detecteion, the detection results were consistent with sex of infants after delivery; the RASSF1A was amplified all in samples of other 9 cases after BstU1 cleavage, which confirmed existance of cffDNA. The ABO gene detection of cffDNA in plasma showed that out of 20 samples, both non O and B were amplified simultancously in 8 cases, suggesting the B blood group; the non O was amplified, but the B was not amplified only in 5 cases, suggesting A blood group, the non O and B both were not amplified in samples of 7 cases, suggesting O blood group. The above-mentioned detection results were consistent with new born ABO blood group by serological test.</p><p><b>CONCLUSION</b>The proposed protocol for the detection of fetal ABO based on RASSF1A gene by using fetal DNA from maternal plasma can be used for noninvasive prenatal diagnosis of fetal ABO blood group.</p>

Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China: A Multicenter Retrospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China.</p><p><b>METHODS</b>All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed.</p><p><b>RESULTS</b>A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal.</p><p><b>CONCLUSIONS</b>Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.</p>

Role of miRNA-210 in hypoxic-ischemic brain edema in neonatal rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the role of miRNA-210 in hypoxic-ischemic brain edema in neonatal rats.</p><p><b>METHODS</b>A total of 80 neonatal rats were randomly divided into control group, normal saline group, miRNA-210 expression inhibition group, and miRNA-210 overexpression group, with 20 rats in each group. Each group was randomly divided into sham-operation group and hypoxia-ischemia (HI) group, with 10 rats in each group. The neonatal rats in the HI group were treated with ligation of the left common carotid artery and then put in a hypoxia cabin with mixed gas of 8% O2 and 92% N2 for 2 hours; those in the sham-operation group were treated with isolation of the left common carotid artery only, without ligation or hypoxia treatment. After HI or sham-operation, the rats in the normal saline group, miRNA-210 expression inhibition group, and miRNA-210 overexpression group were intracranially injected with normal saline (2.5 mg/kg), miRNA-210 inhibitor (2.5 mg/kg), and miRNA-210 mimic (2.5 mg/kg) respectively. No treatment was given to the rats in the control group. The rats were sacrificed three days later, and the left brain tissue was harvested. Fluorescent quantitative PCR was used to measure the expression of miRNA-210; the dry-wet weight method was used to measure the water content of brain tissue; hematoxylin and eosin staining was used to observe the histomorphological changes in the brain.</p><p><b>RESULTS</b>The HI groups showed significant reductions in the expression of miRNA-210 and significant increases in the water content of brain tissue compared with the corresponding sham-operation groups (P<0.05). Compared with the normal saline HI group, the miRNA-210 expression inhibition HI group showed a significant reduction in the expression of miRNA-210 and a significant increase in the water content of brain tissue (P<0.05), and the miRNA-210 overexpression HI group showed a significant increase in the expression of miRNA-210 and a significant reduction in the water content of brain tissue (P<0.05). The results of hematoxylin and eosin staining suggested that the miRNA-210 expression inhibition HI group showed marked edema, and the miRNA-210 overexpression HI group showed a significant improvement in edema.</p><p><b>CONCLUSIONS</b>Neonatal rats show down-regulated expression of miRNA-210 after HI, suggesting that miRNA-210 may be involved in the development and progression of hypoxic-ischemic brain edema in neonatal rats.</p>

Prediction of microRNA-296-5p target genes and its application in lung development / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To predict the target genes of rno-microRNA-296-5p (miR-296) using bioinformatics software and databases, and to provide a theoretical basis for further studies of biological effects of miR-296 in fetal lung development.</p><p><b>METHODS</b>PubMed and Google were used to search for all reported literature on miR-296. The miRBase database was used to determine the sequence and evolutionary conservatism of miR-296. The TargetScans database was used to predict the target genes of miR-296. The DAVID Bioinformatics Resources 6.8 database was used for the functional enrichment analysis of the target genes. The KEGG database was used to analyze the signaling pathways of target genes.</p><p><b>RESULTS</b>miR-296 was reported to play important roles in many biological processes and have a high degree of sequence conservation among species. The target genes of miR-296 were involved in biological processes, cell components, and molecular function. Those target genes were significantly enriched in the mitogen-activated protein kinase signaling pathway, Wnt signaling pathway, and transforming growth factor-β signaling pathway (p<0.05).</p><p><b>CONCLUSIONS</b>The bioinformatics analysis of the target genes of miR-296 provides a basis for studying biological effects and mechanism of action of miR-296 in lung development.</p>

Clinical analysis of 52 cases of 21-hydroxylase-deficient congenital adrenal hyperplasia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To gain more insight into congenital adrenal hyperplasia (CAH) by analyzing the clinical data of children with 21-hydroxylase-deficient CAH.</p><p><b>METHODS</b>The clinical data of 52 children with 21-hydroxylase-deficient CAH were collected. Based on the disease severity and the presence of salt-losing manifestations, the children were classified into three groups: masculine type (n=15), salt-losing type (n=28), and atypical type (n=9). The clinical data of children with different types of CAH were analyzed and compared.</p><p><b>RESULTS</b>The male-to-female ratio of the 52 cases was 1.6:1; the age of onset was less than 1 month after birth in 41 cases; 4 cases had a positive family history. Clitoral hypertrophy was the most common symptom in children with masculine CAH (87%). Pigmentation (89%), feeding difficulties and growth retardation (61%) were the most common symptoms in children with salt-losing CAH. Pigmentation (78%) was the most common symptom in children with atypical CAH. The three groups of children had different degrees of changes in the levels of adrenocorticotrophic hormone, cortisol, testosterone, and estradiol. Such changes were most pronounced in children with salt-losing CAH and were often accompanied by hyponatremia, hyperkalemia, and metabolic acidosis. After treatment with hydrocortisone and/or 9-alpha fluorohydrocortisone, cortical hormone levels improved in all the children, and the levels of cortisol, testosterone, estradiol, and electrolytes improved significantly after treatment in children with salt-losing CAH (P<0.05). In 22 patients who were followed up, 9 were re-hospitalized due to infection, and 8 developed sexual precocity.</p><p><b>CONCLUSIONS</b>Different types of CAH have different clinical symptoms. It is important that hormone replacement should be initiated as early as possible to improve prognosis.</p>

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China.</p><p><b>METHODS</b>All infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors.</p><p><b>RESULTS</b>A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization.</p><p><b>CONCLUSIONS</b>Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.</p>

Effects of extensively hydrolyzed protein formula on feeding and growth in preterm infants: a multicenter controlled clinical study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of extensively hydrolyzed protein formula (eHF) on the feeding and growth in preterm infants through a multicenter controlled clinical study.</p><p><b>METHODS</b>Preterm infants admitted to eight upper first-class hospitals in China between February 2012 and December 2013 were randomly selected. They were divided into two observation groups and two control groups. The first observation group consisted of preterm infants with a gestational age of <32 weeks, who were fed with eHF for 10-14 days after birth and then with standard preterm formula (SPF) until discharge. The second observation group consisted of preterm infants with a gestational age of 32-34 weeks, who were fed with SPF after birth, but were switched to eHF (7-14 days) if suffering feeding intolerance at 6-8 days after birth. The two control groups with corresponding gestational ages kept to be fed with SPF after birth. Clinical data were recorded to compare feeding condition, physical growth, blood biochemical indices, and major complications between different groups.</p><p><b>RESULTS</b>A total of 328 preterm infants were enrolled. Preterm infants with a gestational age of <32 weeks in the observation group had a significantly shorter meconium evacuation time than in the corresponding control group (P<0.05). They also had significantly lower levels of serum total bilirubin at weeks 1 and 2 after birth compared with the control group (P<0.05). The observation group needed more time in reaching enteral nutrition (EN) basic energy uptake of 50 kcal/(kg·d), partial parenteral nutrition (PPN), hospitalization, and corrected gestational age at discharge compared with the controlled infants (P<0.05). There was no difference in the incidence of extrauterine growth retardation (EUGR) at discharge between the two groups (P>0.05). Preterm infants with a gestational age of 32-34 weeks in the observation group had significantly lower serum total bilirubin levels at 2 weeks after birth compared with the corresponding control group (P<0.05). They required more time in achieving EN basic energy and PPN than in the control group (P<0.05). There was no difference in the incidence of EUGR at discharge between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>For preterm infants, eHF can improve gastrointestinal motility, accelerate bilirubin metabolism and excretion and does not increase the incidence of EUGR.</p>

Bioinformatic analysis of target gene prediction and related signaling pathways of miRNA-126* / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To bioinformatically predict and analyze target genes of miRNA-126(*), with the aim of providing certain basis for related research about target genes and regulatory mechanism in the future.</p><p><b>METHODS</b>The miRNA chip technology was applied to measure expression levels of miRNA-126(*) in 3 time points (embryo 16, 19 and 21 days) of fetal lung development. Then the target genes of miRNA-126(*) were screened through miRGen2.0 database. Subsequent bioinformatic analysis of these target genes was performed by Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes Pathway analysis (KEGG Pathway analysis).</p><p><b>RESULTS</b>miRNA-126(*) manifested continuously upregulated expression with the lung development (from embryo 16 to 21 days). There were 422 predicted target genes in total, and the gene set mainly located in glucuronosyltransferase activity, transferase activity (GO molecular function), multicellular organismal development, developmental process (GO biology process) and intracellular part (GO cellular component). The KEGG Pathway analysis demonstrated that the gene set mostly located in RNA degradation (signal transduction pathway) and prion diseases (disease pathway).</p><p><b>CONCLUSIONS</b>The results suggest that miRNA-126(*) plays a certain role in fetal lung development and provide a basis for lung development research in the future.</p>

Prediction of hsa-miR-26a target genes and application in lung development / 中华实用儿科临床杂志

Objective The bioinformatics software and database were involved in prediction of the target genes of hsa-miR-26a,so as to lay foundation and provide theoretical basis for the further studies of hsa-miR-26a biological function in fetal lung development.Methods All literature of miR-26a were searched in PubMed and Google ; miRBase database was used to obtain the sequence of hsa-miR-26a and to analyze its conservation.The target genes of miR-26a were predicted using miRNA target gene database miRGen2.0.TargetScans and PicTar were used to predict target genes of hsa-miR-26a.The intersection of the 2 results and validated targets from DIANA LAB-TarBase 6.0 datebase was analyzed by gene ontology and pathway analysis.Results Hsa-miR-26a had been reported in cancer,cell differentiation,organ development,the immune system as well as involved in other biological process;hsa-miR-26a was highly conservative among different species.The functions of these target genes were enriched in translation regulation,the protein modification,the regulation of celluar proliferation,apoptosis and differentiation process,kinase activity regulation,target genes exist in all of the cell components,including cell membrane,cytoplasm and nucleus.The Wnt signaling pathway,mitogen-activated protein kinase signaling pathway,transforming growth factor-β signaling pathway,the pathway of tumor p53 signaling pathways,cell cycle and adherens junction pathways were significantly enriched and prostate cancer,small cell lung cancer,colorectal cancer,renal cell cancer and glioma were mainly involved (all P ＜ 0.05).Conclusions The target genes of hsa-miR-26a are enriched in multiple biological process.The prediction and bioinformatic analysis of miR-26a target genes lay the foundation for the further study in fetal lung development.

Clinical evaluation of the effects of morphine in mechanical ventilation of neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of morphine infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in ventilated neonates.</p><p><b>METHODS</b>A randomized, double-blind clinical trial was conducted between August 2010 and April 2011 at the neonatal intensive care unit of Nanjing Children's Hospital Affiliated to Nanjing Medical University. A total of 46 ventilated preterm infants (≥ 32 weeks) and term infants were divided into 2 groups at random. Twenty-two infants in test group received a loading dose (100 µg/kg) of morphine (> 1 h) followed by a continuous infusion [10 µg/(kg·h)] for (70.05 ± 29.05) h, and 24 infants in control group received 5% glucose with the same infusion rate. (1) The ventilatory parameters [respiratory rate (R), frequence (f), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), fraction of inspired oxygen (FiO2)], mean blood pressure (MBP) and heart rate (HR) before treatment, at 30 min, 2 h, 6 h, 12 h, 24 h, 48 h after treatment between two groups were compared. (2) Pain was measured by two assessment tools [neonatal pain, agitation and sedation scale (N-PASS) and COMFORT scale] at the same periods. (3) The ventilation duration, the time from withdrawal to extubation, the total oxygen-inhaled time, the side effects and the clinical outcomes [e.g., pulmonary hemorrhage, air leak, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH)] between two groups were compared.</p><p><b>RESULTS</b>(1) There were no significant differences in the different ventilatory parameters before and after treatment between two groups at different periods (P > 0.05). There was no significant difference in the average blood pressure of two groups at different periods, but the heart rate reduced at 24 - 48 h after treatment in test group with significant difference as compared to control group (t = -2.152 and -2.513, P < 0.05). (2) The N-PASS score and COMFORT score in test group were lower than that in control group at different time points 2 h after treatment (P < 0.05), especially 12 h after treatment (P < 0.01). (3) There were no significant differences in the ventilation duration, the time from withdrawal to extubation and the total oxygen time between two groups, and also in side effects, the incidence of IVH, white matter damage and the clinical outcomes.</p><p><b>CONCLUSION</b>Continuous infusion of morphine could relieve pain in ventilated neonates, reduce the stress response and promote the human-machine coordination, but the medication did not show any effects on neurobehavioral development and short term outcome.</p>

Role of miRNA-126/miRNA-126* in the fetal lung development of rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the expression and role of miRNA-126/miRNA-126(*) in the fetal lung development of rats.</p><p><b>METHODS</b>Twelve pregnant Sprague-Dawley rats were randomly divided into 3 groups and the fetal rats were removed at 16, 19 and 21 days of gestation respectively. Hematoxylin and eosin staining was performed to observe lung morphology of fetal rats. Then microRNA (miRNA) microarray was used to study the expression patterns of miRNA-126/miRNA-126(*) in fetal lungs at the three time points. And miRNA-126(*) was selected for further study by real-time PCR.</p><p><b>RESULTS</b>There was no evident difference in the expression of miRNA-126 among the three groups, however the expression level of miRNA-126(*) increased gradually as the fetal lung developed. The real-time PCR result further showed that expression of miRNA-126(*) increased gradually with lung development, displaying significant differences among the three groups (P<0.05).</p><p><b>CONCLUSIONS</b>miRNA-126(*) may play an important role in development of the fetal lung in rats.</p>

Clinical characteristics of children with acute pancreatitis / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of children with acute pancreatitis and provide the basis of early diagnosis and treatment.</p><p><b>METHODS</b>Totally 121 children with acute pancreatitis admitted to Hunan Children's Hospital between March 2003 and December 2009 were enrolled in this retrospective study. The data of clinical manifestations, biochemical examinations, imaging and prognosis were summarized and statistically analyzed.</p><p><b>RESULTS</b>Of the 121 cases, preschool and school-age children were the main groups, and the prevalent months were May and June. Abdominal pain (88.4%) and vomiting (61.2%) were the major initial symptoms of pancreatitis in children, but none of children under the age 1 year complained of abdominal pain; 70.2% had signs of abdominal tenderness, accompanied by abdominal rigidity, distension, hepatomegaly, jaundice, etc. Severe patients developed shock, convulsions, coma and so on. Serum amylase concentration increased to above the upper reference limit in 114 children (94.2%) when they admitted within 24 hours after admission. Urine amylase elevation was noted in 77 children (79.4%). The amylase concentration decreased after 3 days, but not all returned to normal 14 days afterward. Children with sustained serum amylase elevation or serum amylase level ≥ 3 times upper limit of normal range more likely to have fever, vomiting, abdominal distension, and pancreatic abnormalities at ultrasonography or CT which showed that the echo of pancreas decreased or enhanced, pancreas edema, pancreatic duct expanded, etc. Abdominal ultrasonography and CT showed that 75 cases (62.0%) had other organ damage besides pancreatitis, liver (25.3%) and intestinal (16.0%) damages were very common, while liver and myocardial damages were seen frequently in the laboratory examinations, which complicated with serum ALT/AST, total bilirubin, blood glucose elevation and myocardial enzyme abnormalities. Several gastroscopic examinations showed mucosal hyperemia and edema, sheet-like erosion, etc. Except for one case who underwent laparotomy, all the remaining children were treated with non-operative comprehensive treatment. Of them 119 were cured or improved, 2 died and 5 had recurred disease later.</p><p><b>CONCLUSIONS</b>Gastrointestinal symptoms were the main clinical manifestations of acute pancreatitis in children, often complicated with extrapancreatic damage. The younger the patient was, the less complaint of abdominal pain they had. This indicates that acute pancreatitis should be considered when children suffered from acute abdominal pain and vomiting which had no known cause or could not be explained. It is important to do take serial monitoring of serum amylase, and imaging procedures.</p>

Clinical and pathologic characteristics of pancreatic necrosis in critically ill children / 世界急诊医学杂志（英文）

@#BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis. METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children's Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed. RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP);children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis. CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.

Effects of antenatal administration of dexamethasone and betamethasone on signal transduction of bone morphogenetic protein in the fetal lungs of rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the role of antenatal glucocorticoid (dexamethasone and betamethasone) on bone morphogenetic protein (BMP) signal transduction of the rat fetal lungs.</p><p><b>METHODS</b>Fifteen pregnant rats were randomly divided into five groups: the rats treated with dexamethasone for 1 day (1D-DEX) or 3 days (3D-DEX), with betamethasone for 1 day (1D-BEX) or 3 days (3D-BEX) or with normal saline (control group), followed cesarean section on the 19th day of gestation. The mRNA levels of BMP4, BMPR-II, Smad1 and ATF-2 of fetal rat lungs were ascertained by reverse transcriptase polymerase chain reaction (RT-PCR). The expression of BMP4, BMPR-II, Smad1 and ATF-2 antigen expression in fetal lungs was assessed by immune histochemical staining. The expression of BMP4 and BMPR-II was determined by Western blot.</p><p><b>RESULTS</b>The levels of BMP4, BMPR-II and Smad1 mRNA expression were up-regulated in the 1D-BEX, 3D-BEX and 3D-DEX groups compared with those in the control group (P<0.05). The immune histochemiscal analysis showed that the expression of BMP4, BMPR-II, Phospho-Smad1 (pSmad1) and ATF-2 in the 1D-BEX, 3D-BEX and 3D-DEX groups was significantly higher than that in the control group (P<0.01). The results of Western blot demonstrated that the expression of BMP4 and BMPR-II protein increased significantly in the 1D-BEX, 3D-BEX and 3D-DEX groups when compared with the control group (P<0.01).</p><p><b>CONCLUSIONS</b>Betamethasone and dexamethasone may play important roles in the regulation of BMP signal transduction in the rat fetal lungs. Up-regulation of BMP4, BMPR-II and Smad1 might be one of crucial factors for the glucocorticoid-induced maturity of fetal lungs.</p>

Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders (NARD), and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units (NICUs) in a Chinese neonatal network.</p><p><b>METHODS</b>Data were prospectively collected in 2004 - 2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life.</p><p><b>RESULTS</b>A total of 2677 NARD was classified (20.5% of NICU admissions). There were 711 (5.44%) with respiratory distress syndrome (RDS), 589 (4.51%) pulmonary infection, 409 (3.13%) meconium aspiration syndrome, 658 (5.03%) aspiration of amniotic fluid and 239 (1.83%) transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%, respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively. Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not (P < 0.001).</p><p><b>CONCLUSIONS</b>This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.</p>